The Bentall procedure is the surgical procedure in which the defects of the aorta are treated. The aorta is the largest artery in the human body. When the walls of the aorta become damaged and the artery abnormally swollen or bulge and produce symptoms, the Bentall procedure is performed to correct the defect. In the Bentall procedure, the graft is used to replace the abnormal artery, and the aortic valves are also replaced. Bentall procedure can be performed traditionally as in open heart surgery or it can be performed by the procedure of minimally invasive technique. Like any other surgery, bentall procedure also has some risks and complications associated with it and these complications should be prevented as much as possible. The recovery period can vary according to the condition of the patient but mostly it can take several weeks to months for complete recovery. There is a restriction on doing heavy activities for almost 12 weeks after the surgery. After that, gradually increasing the intensity of exercises is usually recommended before the patient can normally perform all the activities of daily living. Not every patient can be treated with the Bentall procedure as it is one of the major heart surgeries. For example, a person who has unstable blood pressure cannot undergo a Bentall procedure. Because it may complicate the condition of the patient and can even cause death on the spot.
Types of Bentall Procedure Treatment India
Some types of Bentall procedures are performed according to the condition of the patient. These are:
- Traditional Bentall Procedure
- Modified Bentall Procedure
- Button Bentall Procedure
- Hemashield Bentall Procedure
- Valve-Sparing Bentall Procedure
- Bioprosthetic Valve Bentall Procedure
Traditional Bentall Procedure
This is the classic form of the procedure that involves the replacement of the aortic valve and the aorta that runs upward with an artificial graft. A mechanical or biological valve is used along with a synthetic graft to replace the abnormal aorta.
Modified Bentall Procedure
In this type of Bentall procedure, some changes might be made to the surgical technique, such as using different suture techniques or graft materials. The remaining procedure of replacing the aortic valve and the aorta remains the same as the traditional Bentall procedure.
This procedure is also known as the "button Bentall”. This procedure involves reimplanting the branches of the aorta into the graft by using button-like flaps. This can help improve the blood flow in branches of the aorta and reduce the risk of complications.
Hemashield Bentall Procedure
In this type of procedure, a special type of graft material called Hemashield is used for the synthetic tube graft. This material is designed to reduce the risk of infection and other complications related to graft.
Valve-Sparing Bentall Procedure
This procedure is not a true Bentall procedure in the traditional way. This approach involves replacing the aorta while preserving the aortic valve of the patient. This is also known as the David procedure or re-implantation procedure.
Bioprosthetic Valve Bentall Procedure
This involves using a bioprosthetic or tissue valve instead of a mechanical valve. Bioprosthetic valves are obtained from animal tissues and do not require medications to limit the complications related to valves.
Bentall Procedure
The general overview of the Bentall procedure is as follows
Anesthesia
The anesthesia is administered so that the patient cannot feel pain or discomfort during the Bentall procedure.
Incision
An incision is made in the center of the chest on the breastbone to access the heart and the blood vessels.
Aortic Root Dissection
The aorta is dissected, and the impaired aortic valve is also removed for the preparation of the implantation of the graft.
Graft Placement
A synthetic tube graft that is made up of resilient materials is securely stitched in place of the aorta. If the aortic valve replacement is also required, it is attached to the graft—either by a mechanical or a bioprosthetic valve.
Coronary Arteries
The coronary arteries are the branches of the aorta. The openings of the coronary arteries are carefully reattached to the graft. This step is important to maintain continuous blood supply to the heart muscle.
Closure
After the implantation, the incisions are closed by using sutures. Some medications are used to apply on these incisions.
Recovery
In the recovery phase, medications are used to prevent any complications and limited activities are recommended to avoid the extra stress on the heart.
Cost of Bentall procedure in India
The cost of the bentall procedure in India ranges from 3000 USD to 6000 USD. The cost can vary according to the condition of the patient, the facilities of the hospital, and the skill of the surgeon. The cost can also vary according to the types of valve used in the replacement of aortic valve.
- Bentall Procedure : 3576 USD - 5008 USD
- Aortic Valve Replacement-Mechanical Valve : 4262 USD - 5683 USD
- Aortic Valve Replacement-Tissue Valve : 3063 USD - 4049 USD
Symptoms and Risk factors
Some of the indications of the Bentall procedure are as follows:
- Aortic root aneurysm
- Aortic dissection involving the ascending aorta
- Aortic valve dysfunction with ascending aorta involvement
- Connective tissue diseases e.g., Marfan syndrome, Ehlers-Danlos syndrome with involvement of aorta.
- Re-do aortic valve surgery with aortic root involvement
- Aortic root abscess or infection
- Aortic regurgitation due to aortic root dilation or valve pathology
- Aortic stenosis with involvement of the ascending aorta
- Bicuspid aortic valve with associated aortic root disease
- Aortic swelling and bulging which produces abnormal blood flow
- Genetic syndromes associated with abnormalities of the aorta
- Traumatic injury to the aortic root and ascending aorta
- Aortic root pathology causing heart failure or hemodynamic instability.
Risk factors of Bentall Procedure
Some of the risks that are associated with the Bentall procedure are:
Anesthesia Risks
Some patients have adverse reactions to anesthesia like allergic reactions. Anesthesia also has the risk of infertility.
Bleeding and Hemorrhage
There is a risk of bleeding during and after the procedure when incisions are closed. Excess bleeding will require further medical management and may also complicate the recovery.
Infection
Like any surgery, there is always the risk of developing an infection. The risk is higher in people who have low immunity.
Blood Clots
There is a risk of blood clot formation. Blood clots can travel to major organs like the lungs, brain, and heart and may risk the life of a patient.
Heart Attack
Sometimes the blood flow is not proper to the muscles of the heart which can lead to a heart attack.
Valve Dysfunction
Valve dysfunction can be the risk in which valves do not function properly and also have the risk of developing infection.
Arrhythmias
There is a risk of an abnormal rhythm of heartbeats that can complicate the recovery process and can also produce severe complications.
Kidney Dysfunction
A low supply of blood to the kidney due to insufficiency of the heart to pump blood can damage kidney function.
Respiratory Complications
There are the risks of Breathing difficulties, lung infections, or pneumonia after the surgery.
06/24/2024
